Cade M. Nylund, MD, assistant professor of pediatrics at the Uniformed Services University of the Health Sciences in Bethesda, Md., and colleagues analyzed a national database of children discharged from hospitals in 1997, 2000, 2003, and 2006. Of 10.5 million total cases, only 0.2% had C. diff infections, but the number of cases increased by about 15% per year.

Incidence, severity, and deaths from C. diff in adults have also been increasing. Unlike adults, however, the authors did not observe an increase in severity of the disease for children over this time period. Infection, however, was associated with increased risk of death, higher colectomy rates, longer hospital stays, and higher costs.

Dr. Nylund says it is difficult to explain why is increasing in hospitalized children, but it might reflect antibiotic treatment practices, since prior antibiotic exposure is considered a risk factor. It also could be due to a more virulent strain of C. diff commonly found in hospitals, or the fact that healthcare providers are more aware of the need to test symptomatic patients for this infection.

According to Dr. Nylund, pediatric hospitalists should be aware of the significant impact of C. diff. "These children are more likely to stay in the hospital or die," he says. He suggests paying attention to such risk factors as antibiotic use, immune system suppression, and persistent diarrhea, as well as the need for a differential diagnosis. Appropriate and early isolation is important, as is hand-washing with soap and water, not using just alcohol-based hand gels, he adds.

"A lot of antibiotics are used to treat C. diff, some of them off-label," Dr. Nylund says. "I get phone consults, typically for difficult, recurring, and chronic cases. It seems like I'm receiving those calls more frequently."

For more information on treatment of C. diff, check out the Key Clinical Question in the March 2009 issue of The Hospitalist.